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Purpose The prevalence of rickets is increasing worldwide in association with an increase in vitamin D deficiency. This study aimed to investigate the vitamin D profile of healthy school-aged children in a sun-rich country and its contributing factors. Methods This cross-sectional study was conducted in 120 healthy children from 7–12 years of age who live in Jakarta, Indonesia. Their demographic status, sun exposure duration time, and lifestyle were recorded using a structured questionnaire. Serum calcium, phosphate, bone-alkaline phosphatase (B-ALP), and 25-hydroxy vitamin D (25(OH)2D3) levels were measured. The participants were categorized into vitamin D sufficient and non-vitamin D sufficient groups, and we analyzed variables that contributed to the 25(OH)2D3 level. Results Of the participants, 73 (60.8%) were vitamin D sufficient, 45 (37.5%) were vitamin D insufficient, and 2 (1.7%) were vitamin D deficient. Sex, age, body mass index, Fitzpatrick skin type, daily milk intake, and clothing type were not different between the vitamin D sufficient and non-vitamin D sufficient groups. There were no differences in serum calcium, phosphate, and B-ALP between the 2 groups. Sun exposure time was significantly longer in the vitamin D sufficient group compared with that in the non-vitamin D sufficient group (511.4 min/wk vs. 318.7 min/wk, P=0.004), and this effect remained consistent on multivariate analysis after adjustment for covariates (adjusted odds ratio, 1.002; 95% confidence interval, 1.000–1.003). More participants in the vitamin D sufficient group did not use sunscreen (59 vs. 27, P=0.02), but this finding was inconsistent with our multivariate analysis. Conclusions Despite year-round sun exposure, approximately 1 in 3 primary school-aged children had insufficient vitamin D level. Sun exposure duration was a major contributing factor.

Background Menarcheal age is important in adolescent girls due to its associations with health outcomes at adulthood. Modifiable factors that may influence menarcheal age include body fat mass and fat distribution. Objective: To investigate possible correlations between body fat mass and fat distribution with age at menarche in adolescent girls. Methods This study was a cross-sectional study on 32 girls aged 10-15 years in Central Jakarta, who experienced menarche within the time period of July to September 2019. Data on menarcheal age was collected by recall. Body fat mass and distribution were calculated using anthropometric measurements and bioelectrical impedance analyzer (BIA) results. Results The mean age of study subjects was 12.06 (SD 0.82) years and the mean age at menarche was 11.91 (SD 0.83) years. Correlation tests revealed a moderate negative correlation between body mass index-for-age and menarcheal age (r= -0.45; P=0.01) and weak negative correlation between waist-height ratio and menarcheal age (r= -0.37; P=0.03). Conclusion Menarcheal age is correlated with body mass index-for-age and waist-height ratio. However, no significant correlations between menarcheal age and body fat mass or distribution are found.

Non-communicable diseases (NCDs) constitute a significant public health challenge and pose a great burden on health and social systems throughout the world. The Asia-Pacific region is in a vulnerable position as the prevalence of NCDs will inevitably increase with rapid socioeconomic transitions; yet it is ill prepared for this public health challenge as Asian children are among the most physically inactive in the world. Aligned with the WHO’s global strategy to control NCDs via preventive measures and health promotion policies, representatives from the Asia-Pacific region came together to develop consensus statement on integrated 24-hour activity guidelines for children and adolescents. These guidelines apply to children and adolescents, aged 5–18 years, in the Asia-Pacific region, regardless of gender, cultural background or socioeconomic status. These guidelines aim to provide the latest evidence-based recommendations, taking a holistic approach to lifestyle activities and adopting a practical perspective by framing these activities within a 24-hour period. Eating and dietary elements were incorporated as they closely influence the energy balance of the movement behaviours and vice versa. By investing in the younger generations through advocacy for healthier lifestyles, we aim to reduce the burden of NCDs in the Asia-Pacific region.

Isolated growth hormone (GH) deficiency (IGHD) type 2 is a rare autosomal dominant disorder characterized by severe short stature with low GH level. Timely diagnosis is important for optimal results of recombinant human GH (rhGH) treatment and detection of additional pituitary deficiencies in affected relatives. A male child presented at the age of one year with severe, proportionate short stature [-4.9 standard deviation score (SDS)] and with a normal body mass index (-1.1 SDS). Physical examination revealed frontal bossing, midfacial hypoplasia, normal external genitalia and no dysmorphic features. Paternal and maternal heights were -6.1 and -1.9 SDS. Serum insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 were undetectable and the peak GH concentration by clonidine stimulation test was extremely low (0.18 ng/mL). Brain magnetic resonance imaging showed anterior pituitary hypoplasia. Genetic analysis identified a novel heterozygous mutation (c.291+2T>G) expected to lead to splicing out exon 3 of GH1. rhGH from age 2.4 years led to appropriate catch-up. In conclusion, we identified a novel GH1 gene mutation in an infant with classical IGHD type 2 presentation.

Latar belakang. Heat shock protein 60 (Hsp60) ditemukan pada individu dengan Diabetes Mellitus (DM) tipe-1 dan merupakan mimikri molecular Hsp65 pada mycobacterium. Fenomena ini dapat menyebabkan penundaan identifikasi mycobacterium dan memperparah kondisi DM tipe-1. Tujuan. Studi ini bertujuan untuk meneliti peran Hsp60 dalam kontrol metabolik terhadap infeksi tuberkulosis (TB) pada anak dan remaja dengan DM tipe-1.Metode. Penelitian ini merupakan studi potong lintang yang dilaksanakan di Rumah Sakit Cipto Mangunkusumo. Anak dan remaja dengan DM tipe I memenuhi kriteria inklusi. Setelah memperoleh data dasar, dilakukan pemeriksaan HbA1c, Hsp60, dan IGRA. Dilakukan analisis data.Hasil. Sebanyak 32 subjek dengan DM tipe-1 diidentifikasi. Insidens infeksi TB yang terdeteksi dengan IGRA pada anak dan remaja dengan DM tipe-1 adalah 12,5%. Tiga dari empat pasien dengan hasil IGRA positif memiliki nilai HbA1c >9.0. Nilai rerata Hsp60 pada subjek IGRA positif lebih rendah dibandingkan subjek IGRA negatif (1.16 ± 0.59 vs 115.18 ± 364.73), dengan nilai P>0,05.Kesimpulan. Tidak didapatkan hubungan signifikan antara Hsp60 dan control glikemik dengan insidens TB pada anak dan remaja dengan DM tipe-1. Hasil ini mungkin dipengaruhi oleh jumlah subjek yang sedikit, penggunaan IGRA untuk mendiagnosis TB pada anak, dan reaktivitas rendah Hsp60 dengan Hsp65.

Insidens Diabetes Mellitus (DM) Tipe-1 pada anak di dunia dan Indonesia terus meningkat. Berdasarkan data Ikatan Dokter Anak Indonesia (IDAI), tercatat 1220 dengan DM tipe-1 pada tahun 2018. Kesadaran masyarakat dan tenaga kesehatan mengenai DM pada anak masih rendah, yang direfleksikan melalui tingginya angka anak yang terdiagnosis dengan DM tipe-1 saat mengalami ketoasidosis diabetikum mencapai 71% pada tahun 2017. Berdasarkan pedoman IDAI, terdapat lima pilar penanganan DM tipe-1 pada anak: injeksi insulin, pemantauan gula darah, nutrisi, aktivitas fisik, dan edukasi. IDAI merekomendasikan insulin minimal dua kali per hari menggunakan insulin basal dan kerja cepat. Pemantauan gula darah mandiri dilakukan minimal 4-6 kali per hari. Keterlibatan pemegang kebijakan, termasuk pemerintah, dan dukungan masyarakat dibutuhkan agar anak dengan DM tipe 1 tertangani dengan baik.

An unhealthy diet during childhood directly impacts the risk of developing noncommunicable diseases (NCDs) later on in life. However, well-documented information on this issue is lacking. We investigated the dietary quality of young Indonesian children and assessed the relationship to serum adiponectin levels as an early marker of NCDs. Eighty-five (44 girls and 41 boys) Indonesian preschool-age children in East Jakarta were included in this study. Dietary intake data were gathered by collecting repeated 24-hour recalls for one weekday and one day during the weekend, which were then further converted into participants’ Healthy Eating Index (HEI) 2015 scores. Meanwhile, an enzyme-linked immunosorbent assay was performed to determine the serum adiponectin level. A multiple regression analysis was performed to assess the association between the HEI 2015 score and serum adiponectin, adjusting for potential confounders. The mean HEI 2015 score was 33.2 ± 8.3 points, which was far below the recommended score of ≥ 80 points, while the mean serum adiponectin was 10.3 ± 4.1 μg/mL. Multiple linear regression testing showed that a one-point increase in the HEI 2015 score was significantly associated with an increase in the serum adiponectin level by 0.115 μg/mL after adjusting for exclusive breastfeeding history (β = 0.115; 95% CI = 0.010–0.221; p = 0.032). In conclusion, better adherence of young children to a healthy diet has a positive association with their adiponectin level. This result suggests that strengthening children’s dietary quality from an early age by involving all parties in the children’s environment (e.g., parents, teachers at school, policymakers) may help to reduce the risk of NCDs later on in childhood and during adult life.

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years), Kupang, Indonesia, three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p &lt, 0.01) and r = 0.43 (p &lt, 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p &lt, 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p &lt, 0.01) and in underprivileged children (r = 0.20, p &lt, 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

Newborn screening (NBS) is an effective public health policy to detect congenital disorders. In 2014, Indonesia marked its pivotal step by launching a national NBS program for congenital hypothyroidism (CH). The expansion of NBS program is expected. This study aimed to evaluate the feasibility and recall rates of NBS for CH and congenital adrenal hyperplasia (CAH). A preliminary study was conducted in 5 cities in Indonesia from October 2015 to January 2016. All newborns aged 2-5 days with gestational age ≥36 weeks were included in the study. Identity, gender, and age at the time of testing, and gestational age were recorded. The heel prick dried blood samples were taken and transported to the appointed standardized laboratories for TSH and 17-OHP testing. Samples were tested using immunoassay. A positive screen test prompted recalling for confirmatory testing and referral to pediatric endocrinologists. Out of 1226 patients, 1126 were screened for TSH while 1188 were tested for 17-OHP. The median age was 2 (2-5) days. The recall rate for CH was 1/1167 (0.09%). The patient was recalled and was found to be a true positive case. Out of 1188 patients who were screened for CAH, 8 had positive results (0.71%). After recalling, only 3 patients screened for CAH came for confirmatory testing, and 2 were found true positives. High rates of CH and CAH in Indonesia indicate the need of mandatory NBS program. CAH screening results in high false positive values; hence, second tier screening should be considered. Government support, good partnership with health services, and increased society awareness are of importance.Studi Preliminer Skrining Hipotiroid Kongenital dan HiperplasiaAdrenal Kongenital pada Bayi Baru Lahir di IndonesiaSkrining bayi baru lahir (newborn screening/NBS) adalah kebijakan kesehatan masyarakat yang efektif dalam mendeteksi penyakit kongenital. Pada tahun 2014, Indonesia meluncurkan program NBS nasional untuk mendeteksi hipotiroid kongenital (HK). Penelitian ini bertujuan untuk mengevaluasi kelayakan dan recall rate program NBS untuk HK dan hiperplasia adrenal kongenital (HAK). Penelitian ini dilakukan di 5 kota di Indonesia pada bulan Oktober 2015 hingga Januari 2016. Subjek penelitian adalah neonatus berusia 2-5 hari dengan usia kehamilan ≥36 minggu. Data identitas, jenis kelamin, usia saat skrining, dan usia kehamilan dikumpulkan. Sampel darah kering yang diambil dengan heel prick diuji TSH dan 17-OHP. menggunakan immunoassay. Jika hasil positif, maka subjek dipanggil kembali untuk uji konfirmasi dan rujukan ke spesialis endokrinologi anak. Dari 1226 subjek, 1126 diuji untuk TSH dan 1188 diuji 17-OHP. Median usia 2 (2-5) hari. Recall rate untuk HK 1/1167 (0,09%). Subjek dipanggil kembali dan memiliki hasil uji konfirmasi positif. Dari 1188 subjek yang diskrining untuk HAK, 8 memiliki positif (0,71%). Hanya 3 subjek yang datang untuk uji konfirmasi dan 2 subjek positif. Tingginya angka HK dan HAK di Indonesia mengindikasikan kebutuhan akan program NBS nasional. Skrining HAK memiliki nilai positif palsu yang tinggi, sehingga skrining lapis kedua perlu dipertimbangkan. Dukungan pemerintah, kerja sama yang baik dengan layanan kesehatan, dan peningkatan kesadaran masyarakat penting untuk mendukung suksesnya program ini. &nbsp

Objectives We performed a cross-sectional study on anthropometric and laboratory characteristics of inhabitants of Rampasasa (Flores, Indonesia). Adults were categorised according to ancestry into three groups: pygmoid (P/P, offspring of pygmoid parents, n=8), mixed pygmoid (P/N, offspring of pygmoid and non-pygmoid parents, n=12) and non-pygmoid (N/N, n=10). Children (n=28) were P/N. Methods Measurements included height, weight, sitting height, arm span, head circumference, haematological analysis and serum albumin, calcium, vitamin D, insulin-like growth factor-I (IGF-I) and IGF binding protein 3 (IGFBP-3). Pubertal stage and bone age was assessed in children. Anthropometric data were expressed as standard deviation score (SDS) for age. IGF-I, IGFBP-3 and IGF-I/IGFBP-3 ratio were expressed as SDS for age, bone age and pubertal stage. Results Mean height SDS showed a gradient from P/P (−4.0) via P/N (−3.2) to N/N (−2.3) (−3.4, −3.1 and −2.2 adjusted for age-associated shrinking). Sitting height and head circumference showed similar gradients. Serum IGF-I SDS was similar among groups (approximately −1 SDS). IGFBP-3 SDS tended toward a gradient from P/P (−1.9) via P/N (−1.5) to N/N (−1.1), but IGF-I/IGFBP-3 ratio was normal in all groups. In P/P and P/N, mean head circumference SDS was >2 SD greater than mean height SDS. Children showed a progressive growth failure and bone age delay, delayed female pubertal onset and an initial low serum IGF-I, normal IGFBP-3 and low IGF-I/IGFBP-3 ratio. Conclusions P/P showed proportionate short stature with relative macrocephaly and relatively low IGFBP-3; P/N presented an intermediate pattern. P/N children were progressively short, showed delayed skeletal maturation, delayed puberty in girls and low IGF-I and IGF-I/IGFBP-3.

The prevalence of type 1 diabetes mellitus (T1DM) in children in Indonesia is increasing although the real number is unknown due to high rate of misdiagnosis. Public and healthcare awareness on T1DM in children is still low, reflected by the high number of children diagnosed with diabetic ketoacidosis (DKA). The Indonesian Pediatric Society (IPS) had published a guideline on T1DM management, which consists of insulin injection, daily monitoring of blood glucose, nutrition, physical activity, and education. Aside from low awareness, current challenges on T1DM management in Indonesia are funding by the national health insurance, fasting during Ramadan, and inequities on DM care. The involvement of society, healthcare workers, stakeholders, and the government is of importance to ensure optimal management for children with diabetes.

BACKGROUND Congenital hypothyroidism is one of the most prevalent, albeit preventable causes of intellectual disability. This study determined the intellectual outcome and health-related quality of life (QoL) in children and adolescents clinically diagnosed with congenital hypothyroidism and the associations among age of starting thyroid hormone treatment, current free thyroxine (FT4) level, intelligence quotient (IQ), and QoL.METHODS Intelligence (Wechsler scales) and QoL (PedsQLTM 4.0 parent proxy-report) tests were administered to 25 patients with congenital hypothyroidism in the pediatric clinic of Cipto Mangunkusumo Hospital, Jakarta. Nineteen patients underwent thyroid ultrasonography or scintigraphy to determine the etiology of congenital hypothyroidism.RESULTS A total of 25 patients with the median age of 9 (5.5–12.5) years were recruited. Eighteen patients had a total IQ of

This global pandemic negatively affects many aspects of children and adolescent health in Indonesia, including our journey in achieving SDGs. Even before the pandemic, our country is not yet on the right track in our SDGs journey with no national comprehensive programs. If we do not urgently address the problems in our nation’s health system, the COVID-19 pandemic can be detrimental to our SDGs progress.

Vaccines are one of the most successful health interventions in history. Yet, vaccine-preventable diseases still claim the lives of 2.5 million individuals globally every year. Approximately 60% of the 19.4 million infants that did not have access to routine immunization services in 2018 live in 10 countries, one of which is Indonesia. In order to reach global targets, it is critical for countries such as Indonesia to prioritize, tailor, and operationalize vaccination strategies to address immunization gaps. Pediatricians and national pediatric societies (NPS) are trusted stakeholders in their countries and are uniquely qualified to promote vaccination programs. The American Academy of Pediatrics (AAP) partnered with the Indonesian Pediatric Society (IPS), with support from the US Centers for Disease Control and Prevention (CDC), to initiate a multiyear project to build the capacity of IPS, individual members, and other child health clinicians to strategically advocate for improved immunization services across both public and private sectors.

Background: Since the 19th century, sexual dimorphism has been known to be sensitive to adverse environmental conditions. Migrants are sensitive to economic and political affluence, and tend to adjust in height towards height of their hosts. We aim to study growth, sexual dimorphism, and height of native and migrant children in three primary schools in Nabire, Papua, Indonesia. Material and Methods 1: Cross-sectional data on height were obtained from 186 children (59 and 56 native Papuan girls and boys, respectively; 38 and 33 trans-migrant girls and boys respectively; who are aged 7.0-7.7 (mean 7.45) years from three primary schools in Nabire, Papua, Indonesia. The Indonesian National Growth Charts were used as references for height. Results 1: With 118.4 cm (SD 6.7) cm, trans-migrant 7-year old boys were almost 3 cm taller compared to their native-age-matched-peers (115.7 cm (5.0 SD) cm, p < 0.05). The case was different among the girls. Trans-migrant girls were not significantly taller than native girls. Material and Method 2: We re-analyzed the height data from over 300,000 infants, children and adolescents, age 0-18 year, from 34 Indonesian provinces. The data were obtained from the latest Indonesian 2013 National Basic Health Survey (NHBS), and have previously been used to construct National Indonesian Growth Charts. St. Nicolas House Analysis was used to translate correlation matrices into network graphs and visualizing chains of associations between parameters that were multiply correlated. Results 2: St. Nicolas House Analysis suggested that the growth of male sex were more sensitive to population crowding, and that crowding contributes to the greater height dimorphism in taller populations. Conclusion: Economic prosperity and increased population density stimulate male adult height to a greater extent than female adult height, and increase the sexual dimorphism in height among the tall populations of densely populated wealthy countries.

Background: Turner syndrome is characterized by the absence of part of or the entire X chromosome in a woman, resulting in short stature, gonadal dysgenesis, and congenital anomaly. Based on karyotype, Turner syndrome is categorized as classical (45XO) and mosaic. The aim of this study is to evaluate the correlation of the karyotype with the puberty stage, volume of the uterus, and ovary in Turner syndrome’s adolescent with estrogen therapy. Methods: Analytic correlative cross-sectional study was done in Pediatric Endocrinology Outpatient Clinic at Cipto Mangunkusumo National Hospital since July to December 2018. Pubertal staging based on Tanner stage, uterine, and ovary volume were measured by transrectal sonography. Results: Of 21 study subjects, 8 were having classical karyotype and 13 were having mosaic karyotype in 12–21-year-old subjects. There was a significant correlation between karyotype and Tanner M stage (mammae stage) (p = 0.035). Breasts development in Turner syndrome with mosaic karyotype showed better development compared to classic karyotype. No significant correlation was found between karyotype and uterine and ovary volume in sonography transrectally. Conclusion: Karyotype correlates to mammae stage of Tanner but not in uterine and ovary volume in adolescents with Turner syndrome who underwent estrogen therapy.

Diabetes Mellitus tipe-1 merupakan salah satu penyakit kronis yang sampai saat ini belum dapat disembuhkan. Walaupun demikian, berkat kemajuan teknologi kedokteran kualitas hidup pasien DM tipe-1 dapat terpelihara. Sebagian besar kasus DM pada anak termasuk di dalam DM tipe-1, namun sedikit sekali tulisan di Indonesia mengenai karakteristik klinis dan laboratorium DM tipe-1. Hal ini mengakibatkan banyak tenaga medis yang tidak mengetahuinya sehingga sering sekali salah dalam mendiagnosis pasien DM tipe-1. Pasien DM tipe-1 sebagian besar mempunyai riwayat perjalanan klinis, dengan poliuria, polidipsia, polifagia, dan berat badan yang cepat menurun. Untuk mengurangi keterlambatan diagnosis maka kewaspadaan terhadap DM tipe-1 merupakan kata kunci. Telah dilakukan penelitian deskriptif retrospektif pada semua pasien DM tipe-1 yang berobat ke Bagian IKA-RSCM antara tahun 1989-1999. Seluruh subyek penelitian diambil dari catatan medis dan didapat 41 kasus dengan DM tipe-1 dengan sebagian besar anak perempuan. Usia terbanyak saat datang pertama kali ke Bagian IKA-RSCM pada usia 5-10 tahun (56%). Dari 41 kasus DM tipe-1, hanya 31% yang mempunyai keturunan keluarga DM. Saat datang ke Bagian IKA-RSCM 66% dengan katoasidasis diabetik, 71% menderita gizi kurang dan seluruh pasien datang dengan keluhan poliuria, polidipsia, polifagia dan adanya penurunan berat badan yang progresif. Gangguan kesadaran juga menyertai pasien dengan KAD. Kadar gula darah pasien DM tipe-1 terbanyak antara 300-500 mg/dl (51%). Semua pasien pada saat awal diagnosis kadar HbA1c di atas normal dan C-peptida di bawah normal.

Gejala klinis hipotiroidisme kongenital pada neonatus seringkali tidak begitu jelas dan baru terdeteksi setelah 6-12 minggu. Diagnosis dini sangat penting untuk mencegah timbulnya retardasi mental atau meringankan derajat retardasi mental. Penelitian ini bertujuan untuk mengetahui gambaran klinis awal, laboratorium dan respons terapi awal natrium levotiroksin pada pasien hipotiroidisme kongenital. Data dikumpulkan dari catatan rekam medik kasus-kasus hipotiroidisme kongenital yang berkunjung ke Poliklinik Endokrinologi Anak dan Remaja FKUI/RSCM Jakarta selama kurun waktu 1992-2002. Dalam kurun waktu tersebut terdapat 30 pasien baru, 21 anak (70%) perempuan dan 9 anak (30%) laki-laki. Sebagian besar (53,3%) didiagnosis pada umur 1-5 tahun. Berdasarkan status antropometri menurut NCHS-WHO ditemukan gizi buruk pada 53,3% kasus (berat badan/umur), perawakan pendek paa 90% kasus (tinggi badan/ umur), dan pada 70% kasus perbandingan berat badan/tinggi badan adalah normal. Gejala klinis tersering saat diagnosis adalah perkembangan motorik terlambat (83,3%), konstipasi (73,3%), aktivitas menurun (70%), makroglosia (70%), dan pucat (70%). Ditemukan maturasi tulang terlambat (95,5%), gangguan pendengaran (22,7%), gangguan sistem neuromuskular (16,7%), dan retardasi mental (62,5%). Pada pemeriksaan skintigrafi dijumpai agenesis tiroid pada 11,1% kasus. Sebagian besar (26,7%) mendapat terapi awal dosis tinggi (8-10 mg/kg/hari). Gejala klinis berkurang (36,7%) dalam 4 minggu dan fungsi tiroid kembali normal (33,3%) dalam 1-3 bulan setelah terapi awal.

Latar belakang. Dermatitis atopik (DA) merupakan manifestasi awal atopic marchyang berhubungan dengan alergi makanan. Alergen penyebab dan faktor risiko yang memengaruhi penting diketahui. Tujuan. Mengetahui sensitisasi dan faktor risiko alergi pada DA setelah usia 2 tahun. Metode. Penelitian deskriptif potong lintang terhadap 35 subjek DA sejak Januari-Maret 2011. Sensitisasi diketahui dengan uji tusuk kulit. Hasil. Sensitisasi terjadi pada 29 subjek dari 35 subjek, dengan faktor risiko pajanan asap rokok ditemukan pada 21 subjek, faktor risiko alergi sedang dan tinggi 19 subjek, tidak mendapat ASI eksklusif 9 subjek, dan makanan padat usia dini 21 subjek. Sensitisasi alergen makanan ditemukan pada 26 subjek. Kesimpulan. Sebagian besar subjek DA mengalami sensitisasi oleh alergen makanan. Faktor risiko pajanan asap rokok, faktor risiko alergi sedang dan tinggi, tidak mendapat ASI eksklusif, dan mendapat makanan padat usia dini ditemukan lebih sering pada anak DA

Latar belakang. Salah satu komplikasi jangka panjang diabetes melitus tipe 1 (DM tipe 1) pada anak adalah nefropati diabetik. Lama menderita diabetes serta masa pubertas merupakan faktor yang mempengaruhi terjadi komplikasi tersebut. Kejadian nefropati diabetik pada umumnya akan disertai gejala peningkatan tekanan darah. Tujuan. Mengetahui gambaran tekanan darah anak dengan DM tipe 1 berdasarkan umur, jenis kelamin, lama sakit, dan kadar HbA1c. Metode. Studi observational retrospektif pada register nasional DM tipe 1 UKK Endokrin Anak IDAI sampai tahun 2010. Variabel yang diteliti adalah umur, jenis kelamin, lama sakit, kadar HbA1c, serta tekanan darah sistolik (TDS) dan diastolik (TDD). Hasil. Di antara 177 anak dengan DM tipe 1, 118 (66,7%) perempuan dan 59 (33,3%) laki-laki. Rerata umur saat pertama kali didiagnosis adalah 11,8 tahun. Dijumpai 1 (0,6 % ) anak perempuan yang menderita DM tipe 1 lebih dari 5 tahun mempunyai tekanan darah sistolik dan diastoik di atas persentil 95. Kesimpulan. Sebagian besar tekanan darah anak dengan DM tipe 1, normal. Terdapat 0,6% kasus dengan hipertensi (>95 persentil) yaitu seorang anak perempuan yang telah menderita DM lebih dari 5 tahun

CLAN (Caring and Living as Neighbours) is an Australian-based non-governmental organisation (NGO) committed to equity for children living with chronic health conditions in resource-poor settings. Since 2004, CLAN has collaborated with a broad range of partners across the Asia Pacific region to improve quality of life for children living with congenital adrenal hyperplasia (CAH). This exploratory case study uses the Knowledge to Action (KTA) framework to analyse CLAN&rsquo, s activities for children living with CAH in the Asia Pacific. The seven stages of the KTA action cycle inform a systematic examination of comprehensive, collaborative, sustained actions to address a complex health challenge. The KTA framework demonstrates the &ldquo, how&rdquo, of CLAN&rsquo, s approach to knowledge creation and exchange, and the centrality of community development to multisectoral collaborative action across a range of conditions, cultures and countries to redressing child health inequities. This includes a commitment to: affordable access to essential medicines and equipment, education, research and advocacy, optimisation of medical management, encouragement of family support groups, efforts to reduce financial burdens, and ethical, transparent program management as critical components of success. Improvements in quality of life and health outcomes are achievable for children living with CAH and other chronic health conditions in resource-poor settings. CLAN&rsquo, s strategic framework for action offers a model for those committed to #LeaveNoChildBehind.

Pertumbuhan anak adalah suatu proses dinamis. Untuk mengetahui bagaimana seorang anak bertumbuh dibandingkan dengan anak sebayanya, diperlukan kurva pertumbuhan sebagai alat pembanding. Kurva pertumbuhan telah digunakan dalam pemantauan perkembangan anak sejak abad ke-18. Berbagai kurva pernah dikembangkan, termasuk kurva referensi dan kurva standar, seperti kurva referensi nasional yang dikembangkan di banyak negara dan kurva standar World Health Organization (WHO) yang digunakan secara internasional sejak tahun 2006. Pemantauan pertumbuhan dilakukan dengan melakukan plot hasil pengukuran ke grafik pertumbuhan, selanjutnya dibandingkan dengan pengukuran sebelumnya. Oleh karena itu, pemantauan pertumbuhan anak secara berkala penting dilakukan. Pengukuran pertumbuhan dengan teknik yang tepat disertai dengan anamnesis dan pemeriksaan fisik dapat mengenali gangguan pertumbuhan sejak dini. Deteksi dini gangguan pertumbuhan menjadi tugas penting orangtua dan tenaga kesehatan. Abnormalitas pertumbuhan juga dapat menandai adanya penyakit dasar yang bersifat kronik serius. Keterlambatan diagnosis dan tata laksana gangguan pertumbuhan menyebabkan potensi genetik anak untuk tinggi tidak tercapai dan anak menjadi pendek.

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents has increased globally over the past 2 decades. Metabolic syndrome, including obesity and overweight at a young age, increases the occurrence of T2DM. Studies in Indonesia have found that obese children and adolescents are more likely to have insulin resistance, a risk factor for T2DM. There are no data on the current incidence of T2DM in youth in Indonesia, but there has been a significant rise in the prevalence of overweight in adolescents. The diagnosis of T2DM in youth is similar to that in adults, with special consideration of when to test asymptomatic children. Management of T2DM in Indonesia follows the recommendations of the Indonesian Pediatric Society, which include lifestyle modifications, such as improving dietary habits and exercise, as well as appropriate medications. Metformin is the drug of choice for young T2DM patients; if marked hyperglycemia is present, basal insulin is given with metformin. Monitoring of T2DM is generally done through selfmonitoring of blood glucose and glycosylated hemoglobin.

Background Children with steroid resistant nephrotic syndrome (SRNS) generally survive, although during the course of disease their kidney function may decrease, leading to end-stage renal disease (ESRD). There have been few studies reporting on the survivals of children with SRNS. Objectives To determine patient and kidney survival rates in children with SRNS at the first, second, third, fourth, and fifth years; and to evaluate the effects of age at onset, initial kidney function, hypertension, and type of resistance, on the survivals of children with SRNS. Methods This retrospective cohort study was performed using secondary data obtained from medical records of patients with SRNS in Department of Child Health, Cipto Mangunkusumo Hospira~ between 2004-2011. The outcomes of kidney survivals were defined in two ways: lack of doubling of base creatinine levels and lack of ESRD. Results There were 45 children with SRNS in our study. Their median duration ofillness was 24 (range 12-95) months. Twenty percent of the subjects died, 31.1 % had a doublingofbase creatinine levels, and 13.4% developed ESRD. Life survival rates of subjects at the first, second, third, fourth, and fifth years after diagnosis were 93 %, 84%, 80"/ri, 7 2% ,and 61 %, respectively. Kidney survival rates determined by the lack of doubling of base creatinine levels at the first, second, third, fourth and fifth years were 92%, 72%, 56%, 42%, and 34%, respectively, while kidney survival rates determined by the lack ofESRD were 97%, 88%, 81 %, 70"/o, and 58%, respectively. Age at onset, initial kidney function, hypertension at onset, and type of resistance, did not significantly affect the survivals of children with SRNS. Conclusion Children with SRNS are prone to develop a doubling of base creatinine levels and ESRD. Factors such as age, initial kidney function, hypertension at onset, and type ofresistance, do not significantly affect both, life and kidney survivals of children with SRNS.

Background Head growth and anterior fontanel (AP) closure are passive processes in response to brain growth. The growth of the brain and skull starts in the third week of intrauterine gestation. roth processes run simultaneously as a part of integral growth, along 'With increasing gestational age, until post􀀿birth. Measurement of head circumference (He) and AF in newborns is done to determine if the brain and skull grew normally during the intrauterine period. Objectives To investigate the differences in He and AF size between preterm and full􀀿term infants, and the relationship between gestational age (GA) and birth weight (BW) to He and AF size. Methods This was a descriptive analytic study on preterm and full􀀿term newborns. Measurement of HC and AF was conducted in three phases: just after birth, 1x24 and 2x24 hours of age. Analysis of HC and AF size differences between preterm and full term subjects was performed, as well as analysis of the correlation between GA and BW to HC and AF size. Results Two hundred fifty newborns completed the study. There were 180 full􀀿term and 70 preterm subjects. Median HC in full􀀿 term and preterm male subjects were 34 cm (range 31􀀿37 cm) and 31 cm (27􀀿34 cm), respectively. Median HC in full􀀿term and preterm female subjects were 33 cm (31􀀿36 cm) and 32 cm (27􀀿3S.S cm), respectively. Median AF in full􀀿term and preterm male subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.S cm), respectively, and in full􀀿term and preterm female subjects were 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively. The HC of preterms were significantly lower than the fullterms (P

Background Congenital adrenal hyperplasia (CAH) is the most common cause of ambiguous genitalia in children and 90-95% cases show 21-hydroxylase deficiency. More than 100 mutations have been described and of these, four mutations have been frequently reported in Asia. Those mutations are deletion/large gene conversion (LGC), intron2 splice mutation (I2 splice), point mutations at codon 172 (I172N) and codon 356 (R356W). Genotyping is very valuable since close correlation observed between genotype and phenotype. Objective To identify phenotype and genotype characteristics of CAH due to 21-hydroxylase deficiency (CAH-21OH) and correlation between them. Methods From June to November 2006 we analyzed 37 confirmed CAH-21OH patients treated at the Department of Child Health, Cipto Mangunkusumo Hospital during the period of 1990-2006. Polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) analysis or amplification-created restriction site (ACRS) were performed. We first identified deletion/ LGC and I172N mutation that had been mostly reported in salt wasting (SW) and simple virilizing (SV) form patients respectively. Results There were 37 patients, consisted of 6 males and 31 females with the ratio 1:5.2. Of those, 25, 10, 2 patients were SW, SV and non-classic (NC) form, respectively. PCR-RFLP or ACRS was performed to detect two mutations in 32 patients (64 alleles). Deletion/LGC was found in 6 alleles while I172N mutations in two. All deletion alleles showed SW phenotype but I172 mutated alleles showed SW and SV phenotype. Conclusion There is a consistent close association between genotype and phenotype in our CAH-21OH patients.

Results Seventy-seven OI cases (39 male), which were diagnosed at the age of 1 9 years old were recorded. Five patients underwent surgery and three patients died before commencing treatment. Nine patients received intravenous pamidronate and sixteen patients received zolendronic acid therapy. Liver and renal functions, as well as serum electrolyte levels were evaluated before and after treatment. Eight patients reported hyperthermia and three others experienced fatigue, bone pain, and abdominal pain within 24 hours of therapy. Serum calcium level decreased in eight patients. No serious adverse effects were documented.

Background The prevalence of underweight children in West Nusa Tenggara is as high as 30%. This region had the third largest number of stunted children in the country. The local government has attempted to tackle this problem by providing supplementary food to underweight children.Objective To assess the success of the community-based food supplementation program onimproving children’s growth in West Nusa Tenggara.Methods We conducted a prospective cohort study for 10 months in Paruga District Primary Health Care Unit, Bima, West Nusa Tenggara, in year 2012. Children were given supplementary food according to the Ministry of Health’s guidelines, consisting of formula milk, high calorie biscuits, and a 60-day supply of eggs, estimated to be sufficient to normalize their weights, for their age and sex. A child’s weight and height were measured every 3 months and the results plotted on WHO growth charts for weight-for-age, height-for-age, and weight-for-height (nutritional status). Z-score -2 SD was classified as normal for all three categories.Results Twenty-five children under five years of age participated in this study. Subjects’ median age was 29 months. None of the subjects had normal weight-for-age Z-score at the beginning of the study. Eighty-four percent (21/25) of the subjects were severely underweight. Only 8% (2/25) of the subjects had normal height-for-age Z-score and 88% (22/25) of them were severely stunted. However, 80% (20/25) of subjects had normal nutritional status (weight-for-height). Changes in weight-for-age Z-score varied throughout the study. The highest median score was in the tenth month of follow up (-3.82). The highest median height-for-age score and weight-for-height score were also in the last month of follow up. At the end of the study, only one subject had normal weight-for-age score (4%) and none of the subjects had normal height-for-age scores. Conclusion The 10-month supplementary food program for under-five children in the Paruga District is not successful in improving body weight and height.

Thyroid hormonal dysfunction, also known as euthyroid sick syndrome or nonthyroidal illness, can be seen in sepsis. There have been few studies on thyroid hormone dysfunction in septic children, as well as on a relationship between their thyroid hormone profiles and pediatric logistic organ dysfunction (PELOD) scores. Procalcitonin (PCT) is one of the sepsis biomarker. Objective To evaluate the thyroid hormone profile in children with sepsis as well as to assess for a correlation between the thyroid levels and PELOD scores, PCT levels, and patient outcomes. Methods This cross-sectional study included children aged 1-18 years admitted to the pediatric intensive care unit (PICU) with a primary diagnosis of sepsis. PELOD scores and thyroid hormonal levels were assessed once during the first 24 hours after PICU admission. Results Thirty subjects were included in the study. The median values of T3, free T4, and TSH were 45 (range 17-133) ng/dL, 0.81 (range 0.3-1.57) ng/dL, and 1.36 (range 0.05-7.78) μIU/L, respectively. The T3, free T4, and TSH levels were decreased in 97%, 50% and 40% of the subjects. There were no significant differences between low and normal to high TSH with regards to the PELOD score (P=0.218), PCT level (P=0.694), or patient outcomes (P=0.55). The risk of death increased by 15 times among the subjects with PELOD score >20 compared to those with PELOD score

In Indonesia report on the natural history of premature thelarche is very limited. Daily practice requires physicians to have some basic practical knowledge, among others the natural history of premature thelarche, in order to manage these patients properly. We reviewed data of 85 premature thelarche patients who visited our department from January 1989 until December 1998. Only 60 patients met the study criteria. The mean chronological age of the patients at diagnosis was 43.4 months. About half of these patients (31/60) were diagnosed before they were 2 years old. Half of the patients had bilateral breast involvement. The hormonal pattern showed 24/48 follicle stimulating hormone predominant-response. Most patients (33/47) showed normal plasma estradiol level. Bone age analysis was normal in 46/57 patients, and only 9 showed accelerated bone age. Pelvic ultrasonography showed prepubertal reproduction organs in 26/35. Vaginal smears showed signs of estrogenization with various degree of stimulation in 13 patients. At the end of observation the outcome of premature thelarche were: 31 regressed, 19 persisted, 6 had progressive breast development and 4 progressed to central precocious puberty. The initial clinical and laboratory characteristics of those who developed CPP varied. Among 31 premature thelarche patients who regressed, 21 had onset of breast enlargement before age of 2 years. In most of the regressed patients (20/31), regression occurred completely within the first year. Most premature thelarche patients with onset before 2 years will regress within one year after diagnosis.

Disorder of Sex Development (DSD) is a congenital condition in which development of chromosomal, gonadal or anatomical sex is atypical. They are complex condition related to social stigma, cultural and beliefs in Indonesian population. In Indonesia, there is only a few study regarding characteristic of DSD patients. The aims of our study was to evaluate the characteristic of patients with DSD in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We retrospectively reviewed the medical records of patients followed up over the period from 2010 to 2012 in Endocrinology Pediatric Clinic, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We found 74 patients with DSD. In this paper we excluded 29 patients confirmed as Congenital Adrenal Hyperplasia and 3 patients with Turner syndrome. Of 42 patients, 23 (54.8%) patients had 46,XY DSD; 11 (26.2%) patients had sex chromosome DSD; 3 (7.1%) patients had 46,XY DSD, and 5 patients have not done chromosomal analysis. The age when first diagnosed was ranging from newborn to 14 years old. Most cases referred by pediatrician (33.3%) and urologist (23.8%) with frequent complaint were ambiguous genitalia (52.4%) and severe hypospadia (14.3%). The most frequent of phenotype was hypospadia (66.7%). Twenty five (59.5%) of patients have been raised as boy prior to diagnosis. Twelve patients were raised as girls have 46, XY karyotype and 2 patients raised as boys have 46, XX karyotype. Definite diagnosis of 23 patients with 46, XY DSD was found only in 4 (17.4%) patients. The problem regarding lack of definitife diagnosis was related with the high cost of laboratory examination and socioeconomic problem in Indonesia. Our study suggest that the most common cause of DSD in our clinic was 46, XY DSD. Karyotype and clinical phenotype may help in establishing the diagnosis.